Clinical and Hemodynamic Effects of Impella 5.5 Therapy in Patients With Cardiogenic Shock

The Impella 5.5 is a large-bore transaortic microaxial flow pump used to treat patients with cardiogenic shock (CS). We sought to assess the hemodynamic and clinical response to Impella 5.5 in patients with CS and identify predictors of clinical deterioration. We reviewed 265 patients who underwent Impella 5.5 implantation from 2020 to 2024 at two institutions to identify patients in CS. Patients with preoperative extracorporeal life support (ECLS) were excluded and a total of 177 patients made up the final study cohort. Fifty patients (28%) deteriorated while on support and needed escalation to ECLS and/or died in-hospital, while 127 (72%) were successfully bridged to heart replacement therapy (HRT) or discharged without need for escalation of device support. Creatinine, lactate, white blood cell count, central venous pressure, and tricuspid regurgitation (TR) severity were all significantly higher in those with clinical deterioration, while pulmonary artery pulsatility index (PAPi) was lower. Rates of stroke, renal failure, and tracheostomy were significantly higher in those who deteriorated. After adjusting for age and sex, both TR and PAPi <2.5 were associated with clinical deterioration. Overall outcomes with Impella 5.5 in CS patients are encouraging; poor baseline right ventricular function appears to be a predictor of worse outcomes with Impella 5.5 in this population.